Hypertensive disorders of pregnancy may be characterized by different maternal cardiovascular phenotypes: hypodynamic (high total peripheral vascular resistance [TPVR], low cardiac output [CO]), hyperdynamic (low TPVR, high CO), and normodynamic (mid-range TPVR and CO). Current anti-hypertensive strategies focus on blood pressure reduction without accounting for the underlying maternal cardiovascular profile, potentially limiting efficacy and tolerability. A three-step, haemodynamic-guided management algorithm could help in treating these women more appropriately according to their different haemodynamic profiles: (1) bedside cardiovascular profiling using transthoracic echocardiography, other non-invasive devices (i.e. NICOM and USCOM) or, when unavailable, the mean arterial pressure/heart rate (MAP/HR) ratio; (2) tailored pharmacotherapy β-blockers (e.g. labetalol) for hyperdynamic circulation, α-methyldopa for normodynamic circulation, and dihydropyridine calcium channel blockers plus nitric oxide donor patches with oral fluid loading for hypodynamic circulation; and (3) haemodynamic reassessment after 7–14 days to refine treatment. Ancillary measures, including activity modification, may further optimize vascular resistance and fetal growth. By targeting the mechanistic determinants of blood pressure (i.e. CO and TPVR) rather than pressure alone, this tailored approach might minimize drug intolerance, attenuate maternal–fetal complications such as pre-eclampsia and fetal growth restriction and prolong gestation. Prospective trials are warranted to validate clinical benefits and long-term outcomes.